Implantable cardioverter defibrillators(ICD) were implanted in 16 patients(pts) with Brugada Syndrome(BS) from 1997 to 2008. All were male (mean age 46.1±12.9 yrs). ICD indication was based on aborted sudden cardiac death(SCD) in 8 pts, syncope in 6 and type I Brugada ECG pattern and strong family history(Hx) in 2 asymptomatic pts. The documented arrhythmias were ventricular fibrillation(VF) in 5, polymorphic VT(PMVT) in 2 and asystole in 1.
The EP study was performed in 13 and induced PMVT/VF in all. Associated cardiac arrhythmias were AF/AFL in 5, AVNRT in 1 and sinus node dysfunction in 1. Single-chamber ICDs were implanted in 16 pts except 2 pts who had dual-chamber ICD because of paroxysmal AF. High defibrillation thresholds were observed in 2 asymptomatic pts(20J, 23J).
During a mean follow-up of 65.5±42.8 months, 4(aborted SCD in 3, prior syncope in 1) of 14 symptomatic pts(28.5%) had a recurrence of ventricular arrhythmias(VA) requiring appropriate device therapy. One asymptomatic pt with family Hx had ventricular storm while asleep 57 months after ICD implantation. Recurrent VAs were well controlled with oral quinidine. Inappropriate shocks occurred in 4 pts(25%) because of AF/AFL in 2, drilling and electrical noise in 1 and sinus tachycardia in 1.
Conclusion ICD is a very effective modality of therapy for the prevention of SCD in BS. Recurrence of VA is more frequent in pts with prior aborted SCD. Despite of judicious medical follow-up, inappropriate shocks occurred in substantial number of patients after ICD implantation.
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